Urinary Tract Infections in Children

What are urinary tract infections (UTIs)?

Urinary tract infections are caused by bacteria along the urinary tract. The urinary tract is made up of 2 kidneys that remove liquid waste from the blood in the form of urine. Narrow tubes called ureters carry urine from the kidneys to the bladder. The urine is stored in the bladder. When the bladder is emptied, the urine travels through a tube called the urethra and passes outside the body.

Who is affected by urinary tract infections?

UTIs are uncommon in children younger than age 5, and unlikely in boys at any age, unless an obstruction is present. They are much more common in girls as a result of a shorter urethra. Uncircumcised males are more likely to develop UTIs than circumcised males. Children with a complete or partial blockage in the urinary tract are more likely to develop UTIs.

What causes a urinary tract infection?

Normal urine is sterile and contains fluids, salts, and waste products. It is free of bacteria, viruses, and fungi. An infection happens when microorganisms, usually bacteria from the digestive tract, cling to the opening of the urethra, travel up into the bladder, ureters, and/or kidneys, and begin to multiply.

Most infections arise from Escherichia coli (E. coli) bacteria. These normally live in the colon.

What are the symptoms of a UTI?

The following are the most common symptoms of a UTI. However, each child may experience symptoms differently. Symptoms may include:

In babies:

Fever

Foul-smelling urine

Irritability

Crying

Fussiness

Vomiting

Poor feeding

Diarrhea

Children:

Sudden need to urinate

Incontinence during day and/or night

Frequent urination

Painful or difficult urination

Discomfort above the pubic bone

Blood in the urine

Foul-smelling urine

Nausea and/or vomiting

Fever

Chills

Pain in the back or side below the ribs

Fatigue

The symptoms of a UTI may look like other conditions or medical problems. Always talk with your child's healthcare provider for a diagnosis.

How are UTIs diagnosed?

Your child's healthcare provider may suspect a urinary tract infection based on physical exam and a description of symptoms. Your child will need to provide a urine specimen for a test called a urinalysis. This is a lab test of urine to check for red blood cells, white blood cells, bacteria, or protein. The urine will also be sent for a culture that will find the presence of an infection.

A boy with a UTI or girls younger than age 5 or 6 may need further testing with a kidney ultrasound. This is a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function. They ae also used to assess blood flow through various vessels.

A voiding cystourethrography may also be needed in some children with recurrent UTI to evaluate the bladder and urethra and to detect reflux. This is when the urine backs up to the kidneys instead of flowing out through the urethra.

What is the treatment for a UTI?

Treatment may include:

Antibiotics

A heating pad or medicines (to relieve pain)

Increased fluid intake (especially water)

Your child's healthcare provider may ask you to bring your child back into the office a few days after treatment starts to reevaluate your child.